Date of Graduation
Doctor of Nursing Practice (DNP)
In this project, psychiatric nurses were trained in patient-centered narrative interviewing approaches and placed in a variety of healthcare sites and conditions to function as consultants. Primary care clinicians (PCCs) in those sites selected patients that each clinician felt was frustrating or difficult and arranged for the consultant to interview them. The consultants then presented patient information to the PCC, data typically difficult to obtain using a standard medical interviewing format. The consultant and PCC discussed the new information provided. The PCC than determined if the information provided was valuable, whether it changed their clinical decision-making regarding this patient's diagnosis and treatment, if their previous level of frustration was improved as a result, and shared other impressions regarding the information or the process.
The purpose of this paper is to first discuss the problem of a clinician-centered approach and the larger context of health care system transformation. Next, the nature of patient-centered interviewing is presented. Then, the project's methodology, implementation, and findings, as a small test of change, are provided. Finally, the lessons learned and implications for advanced practice nursing are offered.
PCCs in this project reported altering their perceptions after consultations with the nurses. As a result of information provided from the interviews, clinicians reported modifications in their patients' diagnoses and treatments. This form of interviewing also reduced clinicians’ self-reports of frustrations and provided them with information they portrayed to be extremely valuable.
The PCCs in this study listed changes they planned to make in their patients' diagnosis and/or treatment plans, and they reported confidence in those decisions and selected a timeframe in which they would take that action. However, it is not known whether any of those clinicians actually followed through on those reports, nor is it known whether outcomes were improved as no chart review was performed in this project.
As a result of participating in this project, it is hoped that PCCs will consider adding a psychiatric mental health nurse practitioner as a consultant to their primary care team in order to continue this service. Or, a PCC may choose to undertake training in patient-centered narrative interviewing as a part of the personal transformation needed to successfully employ a biopsychosocial approach in their practice.
Terry, Michael James, "The Impact of Patient-Centered Narrative Interviewing on the Perceptions of Primary Care Clinicians: a Pilot Evaluation" (2010). Doctor of Nursing Practice (DNP) Projects. 6.